Identifying fall risk using machine learning algorithms

ABSTRACT

A person&#39;s fall risk may be determined based on machine learning algorithms. The fall risk information can be used to notify the person and/or a third party monitoring person (e.g. doctor, physical therapist, personal trainer, etc.) of the person&#39;s fall risk. This information may be used to monitor and track changes in fall risk that may be impacted by changes in health status, lifestyle behaviors or medical treatment. Furthermore, the fall risk classification may help individuals be more careful on the days they are more at risk for falling. The fall risk may be estimated using machine learning algorithms that process data from load sensors by computing basic and advanced punctuated equilibrium model (PEM) stability metrics.

CROSS-REFERENCE TO RELATED PATENT APPLICATIONS

This application claims the benefit of priority of U.S. ProvisionalPatent Application No. 62/186,366 to Forth et al. filed on Jun. 30, 2015and entitled “Method and System for Identifying Balance and Fall Risk,”which is hereby incorporated by reference.

FIELD OF THE DISCLOSURE

The instant disclosure relates to machine learning algorithms. Morespecifically, portions of this disclosure relate to applying machinelearning algorithms to determine patient balance or identify patientfall risk.

BACKGROUND

Unintentional falls account for greater than 30,000 annual deaths withinthe US population. Seniors are most vulnerable to falling and, as aresult, suffer more than 300,000 hip fractures a year. Of those whofracture a hip, 50% will never return to their homes. The poor balancethat contributes to these fall events often declines for decades inadvance of the fall event, yet the conventional method for tackling poorbalance is to seek medical diagnostics and interventions only after afall has occurred or the patient has a very serious balance problem. Infact, the current best predictor of a fall is whether someone hasalready fallen.

To truly improve the statistics of falls across the country, preventiveintervention should be performed in advance of the first fall. Balanceis similar to other physical performances, it can be improved withpractice and, conversely, deteriorates with disuse. A number oflifestyle and health factors are known to influence one's balance, suchas exercise, strength, sleep, cognitive functioning, vitamin Dsupplements, and medication management. Lifestyle changes to improvebalance will take time to build up their protective effect. Measuringbalance and fall risk affords the opportunity to detect subtle balancechanges that can occur with health and lifestyle adjustments.

The human balance control system is very complex with three or moresensory inputs creating a repertoire of motor outputs, each withdiffering strategies that are affected by subconscious and consciouscontrol, experience, context, and personality. The circumstancessurrounding falling further complicates matters as the source of a fallcan be from numerous intrinsic and extrinsic factors. Consequently,predicting falls with a basic measure of balance is insufficient on itsown. The added insight and predictive power that machine learningtechniques provide for human balance control systems can facilitate amore accurate prediction of falls.

One such machine learning approach is discussed in U.S. Pat. No.8,011,229. The '229 patent uses Hidden Markov Model techniques fordetermining postural stability by identifying different postural statesfrom center of pressure (COP) data. COP is the central location ofcombined pressure from 2 or more pressure or load sensors. The posturalstates relate to a classification of either static or dynamic. As thenames suggest, a static postural state is defined as a dwell regionwithin the COP data wherein sway is constrained to a single equilibrium.While a person is in a static state their body sway is considered undercontrol and the person is more balanced and less likely to fall. Adynamic postural state is defined as sections of COP data that are notconstrained to any equilibria and are by definition, unconstrained oruncontrolled. While a person is in a dynamic state they are consideredto be “escaping” an equilibrium and are either moving to anotherequilibrium or falling. The static and dynamic postural statesfacilitate an assessment of postural stability undocumented before,defining a new model of postural control: the punctuated equilibriummodel (PEM). The PEM is defined as periods of stability punctuated bydynamic trajectories. The PEM classification of postural states isparticularly applicable for real-time or near-real-time assessment ofstability. However, subsequent metrics that quantify the postural statesfacilitate a determination of instability trends along longer timelines.Measures of postural instability within the PEM are identified as:number of equilibria, equilibria dwell time and size of equilibria.

There are a number of advantages of the PEM approach. Firstly, thetechnique classifies otherwise uniform data, identifying stable regionsand dynamic trajectories, with the latter being viewed as unstable.Threshold functions are described to identify the postural state usersare in, whether for real-time identification or long term detection ofpostural instability. Further, the approach creates relative measures ofstability that create independence from height and weight, location ofthe feet, or known stability boundaries.

While the preceding approach improved insights into postural stability,it is commonly understood that the multi-factorial nature of falls meansthat predicting falls outside of the real-time and near-real-time fallrange is difficult to achieve. Despite the development to date, thereremains a need for improved postural stability representation.

SUMMARY

Determining a patient's fall risk remains a challenging task.Conventional fall risk indicators are whether an individual haspreviously fallen. Conventional fall risk assessment tests place theindividual at risk, such as by placing the individual into challengingpositions and gauging their stability in that position. However, anegative outcome of the test is a fall, and the test is thus notdifferent from the conventional fall risk indicator. The PEM approachmay be used for determining fall risk of a patient. Machine learningalgorithms may be used to identify combinations of metrics and raw datathat are indicative of an individual's fall risk. Because the PEMapproach does not place the individual in a risky position, theindividual's fall risk can be assessed with little danger to theindividual.

According to embodiments of the present invention, there is provided animproved method for balance and fall risk measurement and analysis thatcomprises the steps of acquiring load data points from at least two ormore load sensors, calculating center of pressure (COP) for each datapoint, and using machine learning algorithms for classifying fall riskbased on the calculated COP. One embodiment of the invention includesthe Hidden Markov Model as the machine learning algorithm. The methodmay then include calculating the current postural state, the nextpostural state and a range of metrics. The metrics can include at leastone of the base punctuated equilibrium model (PEM) metrics, and at leastone of a set of advanced PEM metrics: time to first equilibrium,equilibria distance, equilibria overlap, percent equilibrium, meanequilibria duration, and directional equilibria.

According to some embodiments of the present invention, there isprovided an improved method for balance and fall risk measurement andanalysis that comprises the step of calculating the current posturalstate, the next postural state, and integrating a range of metrics. Themetrics can include at least one of the base PEM metrics, and at leastone of a set of advanced PEM metrics: time to first equilibrium,equilibria distance, equilibria overlap, percent equilibrium, meanequilibria duration, and directional equilibria, and at least one of theCOP basic metrics. An integration of at least one metric from each ofthe base PEM metrics, advanced PEM metrics, and basic metrics can useone of several possible artificial intelligence techniques fordetermining the final balance score and fall risk. These approachesinclude: use of principal component analysis, Bayesian classification,neural network or deep-learning based strategies, and SVMs (supportvector machines). In one embodiment, the integration model is a linearcombination of stability metrics including at least one metric from eachof the base PEM metrics, advanced PEM metrics, and basic metrics. Themetrics are transformed to parameter scores on a scale of 1 to 10 and acomposite balance score is calculated as a weighted average of themetrics. The range of the composite balance score may also be from 1 to10. Thresholds may be assigned to the balance score for classifyingpatients.

The determination of fall risk may be assisted, in some embodiments, bya system that houses load sensors as well as a signal preparation modulethat captures and transmits load data and, therefore, gathersequilibrium data about a person. The system may be a scale including twoor more load sensors that wirelessly transmits load data to a mobiledevice and then to a data analysis module. In some embodiments, thescale may transmit data over a short-range communications link, such asBluetooth or to the mobile device, such as a phone, tablet, or laptopcomputer, which then transmits the data over a long-range communicationslink, such as a wide area network (WAN) through the Internet to a serverwith a data analysis module. In some embodiments, the scale may transmitdata over a short-range communications link to the mobile device, andthe mobile device may include a data analysis module, and the results ofthe data analysis module may be uploaded to a server for monitoringand/or accessing the data. The data analysis module in a mobile deviceor server may perform processing of data, such as executing a machinelearning algorithm and calculating the balance score and fall riskclassification. In some embodiments, the results may be displayed on thesystem for display, such as with LEDs or an LCD on the scale.

In some embodiments, the system may be a device that houses two or moreload sensors, the data analysis module, and a display for outputting theindividual's balance and/or fall risk. The device may include a surfaceupon which an individual can stand comprising two or more load sensors.A data analysis module, such as a processor configured to perform stepsfor executing a machine learning algorithm, may process data from thetwo or more load sensors and generate balance information and/or a fallrisk classification. Illuminating member of the device may comprise LEDlights that illuminate through a semi-transparent top surface creating aglow effect of color that represents the fall risk classification of theuser, and LED numbers illuminating through the top surface may displaythe balance score and weight. The surface device may also include asignal preparation module, which may transmit the load data, balanceinformation, weight, and/or fall risk information to other equipment,such as a mobile device (e.g., a mobile phone, a tablet, a smart watch,a fitness watch, a fitness tracker, a laptop computer) or to a server.The signal preparation module may include communications equipment forcommunicating over either a short range communications link such asWi-Fi or Bluetooth to transmit the data to another computer or theInternet or a long range communications link such as 2G, 3G, or 4Gcellular communications.

100141 In general, technology described in embodiments herein provides asystem and method for determining a person's fall risk and/or compositebalance score. The technology may be used, for example, by seniors,athletes, patients, doctors, physical therapists, nurses, astronauts,and/or any person that needs to assess fall risk or postural stability.

The foregoing has outlined rather broadly certain features and technicaladvantages of embodiments of the present invention in order that thedetailed description that follows may be better understood. Additionalfeatures and advantages will be described hereinafter that form thesubject of the claims of the invention. It should be appreciated bythose having ordinary skill in the art that the conception and specificembodiment disclosed may be readily utilized as a basis for modifying ordesigning other structures for carrying out the same or similarpurposes. It should also be realized by those having ordinary skill inthe art that such equivalent constructions do not depart from the spiritand scope of the invention as set forth in the appended claims.Additional features will be better understood from the followingdescription when considered in connection with the accompanying figures.It is to be expressly understood, however, that each of the figures isprovided for the purpose of illustration and description only and is notintended to limit the present invention.

BRIEF DESCRIPTION OF THE DRAWINGS

For a more complete understanding of the disclosed system and methods,reference is now made to the following descriptions taken in conjunctionwith the accompanying drawings.

FIG. 1 is a block diagram illustrating a conventional balance assessmentmethod.

FIG. 2 is a block diagram illustrating a method for determining basepunctuated equilibrium model (PEM) stability metrics and advanced PEMmetrics according to some embodiments of the disclosure.

FIG. 3 is a block diagram illustrating a method for determining fallrisk using a machine learning algorithm and (center of pressure) COPdata according to some embodiments of the disclosure.

FIG. 4 is a block diagram illustrating a machine learning algorithm fordetermining balance score and fall risk classification based on dataacquired from load sensors according to some embodiments of thedisclosure.

FIG. 5A is a stabilogram of center of pressure (COP) data classifiedinto punctuated equilibrium with Hidden Markov Model techniquesaccording to one embodiment of the disclosure as applied to oneindividual's data.

FIG. 5B is the stabilogram of FIG. 5A with the basic metrics ofmediolateral peak sway (XSWAY) and anterior-posterior peak sway (YSWAY)overlaid.

FIG. 6A is a graph illustrating data of a stabilogram of center ofpressure (COP) data classified by a punctuated equilibrium model (PEM)according to one embodiment of the disclosure.

FIG. 6B shows the same stabilogram of center of pressure (COP) data asFIG. 6A represented by the single equilibrium model of posturalstability with the 95% ellipse identified according to one embodiment ofthe disclosure.

FIG. 7 is a block diagram illustrating a balance score with three fallrisk classifications according to one embodiment of the disclosure.

FIG. 8 is a graph showing data of a Receiver Operating Curve foridentifying falls according to one embodiment of the disclosure.

FIG. 9 is a graph showing data of an individual person's balance scoreand fall risk data over 2 years with annotated balance influencersaccording to one embodiment of the disclosure.

FIG. 10 is a block diagram illustrating a system and data flowthroughout the system according to one embodiment of the disclosure.

FIG. 11A is a perspective view showing the balance device communicatingwith a tablet according to one embodiment of the disclosure.

FIG. 11B is a perspective view showing the balance device communicatingwith a smart phone according to one embodiment of the disclosure.

FIG. 11C is a perspective view showing the balance device communicatingwith a cloud-based data analysis module according to one embodiment ofthe disclosure.

FIG. 12 is an exploded view illustrating a scale balance deviceaccording to one embodiment of the disclosure.

FIG. 13A is an exploded view illustrating a load detecting moduleaccording to one embodiment of the disclosure.

FIG. 13B is a side perspective view illustrating a load detecting moduleaccording to one embodiment of the disclosure.

FIG. 14A is a side perspective view illustrating a scale balance deviceaccording to one embodiment of the disclosure.

FIG. 14B is a rear perspective view illustrating a scale balance deviceaccording to one embodiment of the disclosure.

FIG. 15 is a plan view illustrating a scale balance device and displayaccording to one embodiment of the disclosure.

FIGS. 16A-C are graphs illustrating the results of evaluating fall riskbased on individual metrics for eyes open patients and eyes closedpatients.

DETAILED DESCRIPTION

In general, aspects of the present invention relate to methods andsystems for determining a person's fall risk. The fall risk informationcan be used to notify the person and/or a third party monitoring person(e.g. doctor, physical therapist, personal trainer, etc.) of theperson's fall risk. This information may he used to monitor and trackchanges in fall risk that may be impacted by changes in health status,lifestyle behaviors or medical treatment. Furthermore, the fall riskclassification may help individuals be more careful on the days they aremore at risk for falling. This is in contrast to the general guidelinesfor preventing falls that are unrealistic in their expectation ofincreased vigilance and attention at all times. Alerting someone totheir fall risk level empowers them to take action in the short term,such as to use a cane when the fall risk level is high, or for seekingprofessional advice for making lifestyle changes for long termimprovement of fall risk. In some embodiments, data may be collectedover days, weeks and/or months and long-term predictions formed for theindividual.

FIG. 1 is a block diagram illustrating a conventional method ofclassifying postural states with a Hidden Markov Model (HMM). HMMs aretemporal probabilistic models, modelling a series of states over time.These states are not directly observable, and thus are hidden. However,there is a set of possible observations at each point in time, which maycorrelate to the true hidden state at that time. Therefore, given asequence of observations over a period of time, HMMs determine the mostlikely hidden state.

Conventionally, a HMM may classify postural states from center ofpressure (COP) data. COP data may represent the central location ofcombined pressure from pressure or load sensors over a period of timeand associated with a person. Pressure data is acquired from at leastone pressure sensor over a period of time 110 and the COP is calculatedfor each pressure data point 120. A HMM calculation determines thecurrent and/or next postural state 130. The HMM utilizes a set ofprobabilities for each postural state to determine the next posturalstate 140. The postural states relate to a classification of eitherstatic or dynamic. The static postural state is defined as a dwellregion within the COP data wherein sway is constrained to a singleequilibrium. While a person is in a static state their body sway isconsidered under control and the person is more balanced and less likelyto fall. A dynamic postural state is defined as sections of COP datathat are not constrained to any equilibria and are by definition,unconstrained or uncontrolled. While a person is in a dynamic state theyare considered to be “escaping” an equilibrium and are either moving toanother equilibrium or falling.

The static and dynamic postural states facilitate a punctuatedequilibrium model (PEM) of postural stability. The PEM is defined asperiods of stability punctuated by dynamic trajectories. Alerting aperson to that transient dynamic and thereby dangerous state can helpthem take instant action to avoid the imminent fall. Base measures ofpostural instability from the PEM 150 are identified as: number ofequilibria 160, equilibria dwell time 170, and size of equilibria 180.The number of equilibria 160 may include a number of equilibriaidentified in a time series. The dwell time 170 may include a size of apentagon or other shape that represents the time spent in thatparticular equilibrium. The size of equilibria 180 may include anaverage (or other characteristic such as mean, maximum, or minimum) ofeach point in the equilibrium to the center of the correspondingequilibrium.

Although the base punctuated equilibrium model (PEM) stability metrics160, 170, and 180 may be sufficient for determining postural states.Additional stability metrics may improve determination of posturalstates and/or allow for the determination of fall risk and/orclassifying an individual's fall risk. Embodiments of the invention usemachine learning techniques, such as to classify dynamic and staticpostural states for a PEM with HMM techniques, using advanced PEMstability metrics. The PEM defines multiple equilibria punctuated bydynamic trajectories of COP data series. The PEM approach createsdefined regions and geometric patterns from COP data trajectories. Forexample, FIG. 2 is a block diagram illustrating a method for determiningadvanced PEM metrics, including time to equilibrium 220, equilibriumdistance 230, equilibrium overlap 240, percent equilibrium 250, meanequilibria duration 260, directional equilibria 270.

In one embodiment of calculation of the advanced PEM metrics, data fromat least two load sensors are acquired over a period of time at block110 and associated with a person. The COP data may be calculated fromthe load sensor inputs for each load data point 120. This may generate atime series of COP data. A HMM calculation may be used to determine acurrent and/or next postural state at block 130. The HMM may use a setof probabilities for each postural state to determine a next posturalstate at block 140. In some embodiments, the HMM calculation determinesthe next state, the current state, and/or one or more past states (e.g.five, ten). The postural states may relate to a classification of eitherstatic or dynamic. The static postural state may be defined as a dwellregion within the COP data wherein sway is constrained to a singleequilibrium. The classification of the time series for postural statemay then allow calculations of base PEM stability metrics 150 as well asadvanced PEM stability metrics 210, including time to first equilibrium220, equilibria distance 230, equilibria overlap 240, percentequilibrium 250, mean equilibria duration 260, and directionalequilibria 270. In some embodiments, PEM stability metrics 210 mayinclude time to first equilibrium (e.g., time elapsed before firstequilibrium establishment), equilibria distance (e.g., mean distance ofcenter of equilibria to adjacent equilibria centers), equilibria overlap(e.g., percentage of equilibria overlap of equilibria 95% circle in atime series), percent equilibrium (e.g., percent of time spent inequilibrium in a time series), mean equilibria duration (e.g., meanduration of equilibria in a time series), and/or directional equilibria(e.g., weighted number of equilibria by the degree of anterior posteriordeviation of the directional vector to adjacent equilibria centers fromthe medial lateral, X-axis). Additional details regarding thedetermining the COP data, determining postural states, and determiningbase PEM stability metrics are described in U.S. Pat. No. 8,011,229 toLieberman et al, filed on Nov. 26, 2008 and entitled “Determiningpostural stability,” which is hereby incorporated by reference.

FIG. 3 is a block diagram illustrating a method for determining fallrisk using a machine learning algorithm and (center of pressure) COPdata according to some embodiments of the disclosure. A method fordetermining fall risk begins at block 310 with acquiring load datapoints from at least two load sensors over a period of time. Then, atblock 320, each load data point may be used to calculate center ofpressure (COP) data. Next, at block 330, machine learning algorithms mayreceive the COP data and calculate, for example, postural states. Then,at block 340, the machine learning algorithms may be used to estimatefall risk and/or classify fall risk. In some embodiments, the machinelearning algorithms may be used to classify postural states forcalculating subsequent metrics and determine fall risk thresholds atblock 340. In other embodiments, the machine learning algorithm may beused to classify fall risk as the objective function, either with orwithout the preceding determination of postural states. In someembodiments, the estimated fall risk may also be based, in part, on atleast one of clinical records, exercise, lifestyle inputs, weight, bodyfat composition, body mass index, level of hydration, medicationconsumption, alcohol consumption, sleep, steps per day, exercise, timespent sitting, and/or strength.

FIG. 4 is a block diagram illustrating a machine learning algorithm fordetermining balance score and fall risk classification based on dataacquired from load sensors according to some embodiments of thedisclosure. The COP is calculated at block 320 from the load datareceived at block 310 for each load data point over a period of time.The postural state classification at block 430 classifies two states:static and postural state with HMM techniques. The HMM may utilize a setof probabilities for each postural state to determine the next posturalstate at block 440. A balance integration model may he determined atblock 420 from the base PEM stability metrics calculated at block 450and the advanced PEM stability metrics 210. For example, a balance scoreand/or fall risk determination may be made based, in part, on a weightedcombination of one or more base PEM stability metrics calculated atblock 150 and one or more advanced PEM stability metrics calculated atblock 210. In some embodiments, the balance integration module of block420 may also he based on basic postural stability metrics 410 from aninverted pendulum model (IPM) using one of several possible artificialintelligence techniques. A balance score and/or fall risk classifier maybe generated at block 430 from the balance integration model of block420. Strategies for determining the final balance score include use ofprincipal component analysis, Bayesian classification, neural network ordeep-learning based strategies, SVMs (support vector machines), orsupervised and unsupervised learning approaches more broadly. Inaddition to the stability metrics, raw data, such as COP values overtime or load values over time, may also be provided to the artificialintelligence. In the case of a neural network, the network can betrained (using training data from individuals with a known fall history)to identify combinations of metrics and raw data indicative of fallrisk.

In one embodiment, the balance integration model 420 may be a linearcombination of stability metrics including: at least two of the basicPEM metrics 450 combined with at least two of the advanced PEM metrics210 and at least two of the basic metrics 410 to create a robustrepresentation. The selected metrics may be used to generate a score ona scale of 1 to 10, and for some metrics a logistical functiontransformation may be necessary. Metrics are then weighted to optimizeclassification of fall risk, yielding a balance score at Hock 430.

In some embodiments, the method may incorporate a number of inputmetrics from differing theoretical models. For example, one such modelis the IPM that yields basic COP metrics 410 describing the sway arounda single point. The metrics include anterior-posterior COP peak sway(e.g., maximum anterior-posterior displacement in a time series),mediolateral COP peak sway (e.g., maximum mediolateral displacement in atime series), standard deviation of mediolateral sway, standarddeviation of anterior-posterior sway, the radius of a 95% circle (e.g.,radius of the circle that includes 95% of the COP data in a time series)or ellipse (e.g., radius of the ellipse that includes 95% of the COPdata in a time series), mean speed of COP (e.g., mean of a COP speed ina time series), root mean squared speed (e.g., root mean square value ofthe COP speed in a time series), and percentage time above apredetermined speed (e.g., fraction of time series above 0.1 m/s in atime series), standard deviation of mediolateral position in a timeseries (e.g., stdCopML), standard deviation of anterior-posteriorposition in a time series (e.g., stdCopAP).

FIG. 5 and FIG. 6 illustrate metrics from both postural stabilitymodels, IPM and PEM, respectively. The IPM yield more gross metrics of asingle cluster, while the PEM yields finer metrics as these data havebeen further classified to multiple dusters.

FIG. 5A is a stabilogram of center of pressure (COP) data classifiedinto punctuated equilibrium with Hidden Markov Model techniquesaccording to one embodiment of the disclosure as applied to oneindividual's data. The x axis is the COP mediolateral sway 510, 0 is theleft foot and 1 is the right foot. The y axis is the COPanterior-posterior sway 520 with 1 being anterior direction and 0 theposterior direction. The x and y axis relate to the distance of sway.The different color shades represent different defined equilibria with apentagon 530 of matching color overlaying the clustered regions ofstatic equilibrium. The size of the pentagon represents the relativesize of that equilibrium 530. The larger the pentagon the longer theperson remained in control in that equilibrium. The line within thepentagon 540 represents the mean distance each COP point is from theequilibrium center of the equilibrium it is associated. The points withan outer black line represent points in a dynamic state 550 and thus,have no equilibrium or pentagon associated.

FIG. 5B is the stabilogram of FIG. 5A with the basic metrics ofmediolateral peak sway (XSWAY) and anterior-posterior peak sway (YSWAY)overlaid. The x axis 510 and y axis 520 relate to the distance of sway.The peak anterior-posterior peak sway 570 is the distance between themaximum anterior and maximum posterior sway. Likewise, the mediolateralpeak sway 560 is the distance between the maximum sway points in themediolateral direction. These metrics represent the deviation around thecentral point, and how far the sway deviates from the center.

Similarly, FIG. 6A is a graph illustrating data of a stabilogram ofcenter of pressure (COP) data classified by a punctuated equilibriummodel (PEM) according to one embodiment of the disclosure. FIG. 6B showsthe same stabilogram of center of pressure (COP) data as FIG. 6Arepresented by the single equilibrium model of postural stability withthe 95% ellipse identified according to one embodiment of thedisclosure. In FIG. 6A, the pentagons have been removed, but theclassified regions are clearly indicated by their differing shades ofgrey 610. This is in contrast with FIG. 6B, which illustrates the IPMuniform representation of the time series 620. The 95% ellipse contains95% of all of the data points and is a representation of posturalstability by the total sway area 630. Visually, it is clear to see theHMM classification provides different elements of the stabilogram.Together the metrics from both of these two models: the IPM and the HMM,may provide a more robust and comprehensive approach that neither maycreate in isolation.

FIG. 7 is a block diagram illustrating a balance score with three fallrisk classifications according to one embodiment of the disclosure. Thecomposite balance score 430 has a range from 1 to 10. 10 is the bestbalance, and 1 is the least stable. Thresholds for fall risk can beidentified at block 430 and in FIG. 7 they are defined as high risk forfalling 710 if the person scores 1-3, moderate risk for falling 720 ifthe person scores 4-6 and low risk for falling 730 if the person scores7-10. The thresholds can also be based, in part, on injury state, mentalstate, cognitive state, medical state, movement state, health state,attention state, intoxicated state, and/or hypoxia state.

FIG. 8 is a graph showing data of a Receiver Operating Curve foridentifying falls according to one embodiment of the disclosure. Thecurve provides an evaluation of fall risk classification. These data arebased on 37 subjects, with a mean age 87.09 years, and their fallhistory within a year. The y axis represents the accumulative truepositive identification of a fall occurrence 810, and the x axisrepresents the accumulative identification of no falls 820. Points 1through 10 on the PE line 830 represent each possible score of thecomposite balance score 430. The line of no effect 840 depicts thetheoretical location of equal levels of positive and negativeidentification, and thereby having no discrimination capability. A clearthreshold for maximizing high fall risk classification 710 occurs atscore 3 850. The accumulation of score 1, and 3 yields a sensitivity forcorrectly classifying those at risk for falling as 76%, with a falsepositive rate of 35%, 65% specificity. The rate of identifying falls isminimal from 7 onwards 860 and therefore, classifies the upper, low fallrisk range 730, as illustrated in FIG. 7.

Furthermore, the classified output can be sensitive to subtle changes inbalance created by lifestyle factors. FIG. 9 is a graph showing data ofan individual person's balance score and fall risk data over two yearswith annotated balance influencers according to one embodiment of thedisclosure. Notable periods of increased and reduced balance and fallrisk are related to the participant's activity. A fall event occurredafter the participant scored low and correctly identified as being athigh risk for failing 710. Physical therapy (PT) was prescribed afterthe fall event and coincided with an elevation of the balance score andreduction of fall risk 430. The trend is maintained with specificbalance classes offered in the participant's associated living facility.The end of those classes and a reduction in exercise during the New Yearwas associated with a lower score and greater fall risk. These datadepict the value of this invention for quantifying subtle changes infall risk and empowering people to be proactive about their health.

A system may be used for determining postural stability and fall riskfor a person. The system may include components for capturing load data,processing the data as necessary, transmitting the processed data,performing additional processing of the data based on a plurality ofbalance-related metrics to present balance and fall risk data for theperson in question, transmitting data results, and displaying the datato the user, third party provider, and/or other support personnel toadvise the reader of the person's postural stability and fall risk.

FIG. 10 is a block diagram illustrating a system and data flowthroughout the system according to one embodiment of the disclosure. Thesystem includes two or more load sensors 1020 that collect load data fora period of time. The system may also include a signal preparationmodule 1030 housed within a balance device 1010 with wirelesstransmission capability for transmitting the load data 1070 to acommunication module 1040 and, according to one aspect of the presentinvention, then to a cloud-based data analysis module 1050. The signalpreparation module 1030 may contain analog-to-digital converters (ADCs),timers, and other discrete or integrated components used to convert theoutput of the load sensor module(s) 1020 to digital data values. Thesignal preparation module 1030 may include any general purposeprocessor, a microprocessor, amplifier, other suitably configureddiscrete or integrated circuit elements, and memory. The memory may beany type of volatile or non-volatile storage medium includingsolid-state devices such as DRAM, SRAM, FLASH, MRAM or similarcomponents for data storage. The signal preparation module 1030 may beconfigured with circuitry and/or instructions to process data from theload sensors (e.g., convert analog to digital or otherwise interpret theload sensor signals) and/or package the data for transmission over anetwork connection or other bus (either wired or wireless), such as byforming packets or frames for network transmission or assembling datafor USB transfer. A power source such as a battery (not shown) may beattached by any suitable arrangement for providing power to the circuitsof the load detecting module 1020 and signal preparation module 1030.

In one embodiment, the communication module 1040 may comprise one ormore integrated circuits (e.g. microcontroller, etc.) and/or discretecomponents on a printed circuit board or other electronic packagingtechnology. For example, the communication module 1040 may include a RFtransceiver for transmitting and/or receiving data prepared by thesignal preparation module 1030. The communication module 1040 maytransmit and receive data 1070 over any type of communications link, forexample, the communication module 1040 may include a wirelesstransceiver utilizing an RF network such as a Bluetooth network. Thecommunication module 1040 may include authentication capability to limittransfer of data to only authorized devices. Additionally, thecommunication module 1040 may encrypt data before transmission 1070 inorder to prevent unauthorized access to the information. In someembodiments, the communication module 1040 may include a smartphone,smartwatch, tablet, or laptop that includes the ICs, components, and/orcode described above.

The data analysis module 1050 contains instructions that may be executedby a processor of the data analysis module 1050, which may be local orremote. In some embodiments, the data analysis module 1050 may becoupled to the signal preparation module 1030 to provide a singleapparatus capable of processing and analyzing the COP data anddisplaying results. In some embodiments, the data analysis module 1050may be a laptop, desktop or, cloud-based machine, near or remote from anapparatus with the load sensors, such that the data analysis module 1050receives load sensor data from the communications module 1040. Even whenthe data analysis module 1050 is receiving data from the signalpreparation module 1030, a communication module 1040 may still bepresent to relay results of the balance score and/or fall riskdetermination to a remote location, such as a medical provider.

The data analysis module 1050 may include a processor programmed toreceive the load data 310 or COP data 320 from the communication module1040, which applies machine learning techniques 330 to determine balancescore and fall risk information 430. The machine learning techniques330, including HMM may be performed on a processor. Subsequently, theprocessor calculates the base PEM metrics 150 (e.g., metrics thatinvolve capturing the presence of the postural states), advanced PEMmetrics 210 (e.g., metrics that involve capturing how the posturalstates relate to each other in space and time), and basic stabilitymetrics 410. Advanced PEM metrics may be any metric other than themetrics 160, 170, 180. The results may be stored locally in memory withthe processor and then wirelessly transmitted 1070 for display bydisplay module 1060 or other display or other storage for laterretrieval. A computer program may implement or use the machine learningand balance integration algorithm 420 described in embodiments abovewhen executed by the data analysis module 1050. The modules 1020, 1040,and 1050 may be integrated in a single device, or split between two,three, or more devices.

FIG. 10 also illustrates an embodiment of the system and datatransmission throughout the system. Load data is collected from two ormore load sensors over a period of time. The collected data is processedusing a processor to calculate COP. A processor implements a machinelearning algorithm that calculates basic postural stability metrics 410and PEM metrics based on HMM techniques, including base PEM stabilitymetrics 450 and advanced PEM stability metrics 210. The processorintegrates these metrics to develop a balance output, a fall risk outputor both. The data can be transmitted 1070 along a hard-wired system or awireless system. The signal preparation module 1030, communicationmodule 1040, and data analysis module 1050 and their associatedprocessors can be located in the balance device 1010, or acrossadditional devices, for example, a tablet and the cloud.

In one embodiment, the collected load data 310 may be first processed inthe signal preparation module 1030. The load data 310 is then wirelesslytransmitted 1070 to a mobile device 1040 and then to a cloud-based dataanalysis module 1050. These data are processed on a processor tocalculate COP 320 and subsequently, basic postural stability metrics410, basic PEM stability metrics 350 and advanced PEM stability metrics210. The processor integrates these metrics 420 to determine fall riskand a single balance score 430. The results are stored locally by theprocessor in memory and the results are wirelessly transmitted 1070 tothe mobile device 1040 for display and storage, and further transmittedto the balance device 1010 for display by display module 1060. Althoughthe display module 1060 is shown in the balance device 1010, the displaymodule 1060 may alternatively be located in another device of thesystem, such as a mobile device that includes the communication module1040 and communicates with the balance device 1010.

The balance device 1010 can be any variety of load detecting balance andfall risk devices, including a scale, mat, floor panel, shoe, insole,sock, walker, cane, prosthetic or robotic leg. The communication module1040 can be any variety of a mobile device, smartwatch, smartphone,tablet, computer, cloud-based service and/or data analysis module. Ifthe communication device 1040 is a tablet, the user may hold the deviceor have it near the scale during the test, or attached to a wall infront of the user. FIG. 11A illustrates a perspective view of a balancescale 1010 with a tablet as the communication module 1040, in accordancewith one embodiment of the present invention.

If the communication device 1040 is a smartphone, the user may hold thedevice or have it near the scale during the test or attached to a wallin front of the user. FIG. 11B illustrates a perspective view of thebalance device 1010 with a smartphone as the communication module 1040,in accordance with another embodiment of the present invention. FIG. 11Cillustrates a perspective view of the balance device 1010 with acloud-based data analysis module 1050 as the communication module 1040,in accordance with yet another embodiment of the present invention.

FIG. 12 is an exploded view illustrating a scale balance deviceaccording to one embodiment of the disclosure. In this embodiment thereare 2 main layers: the top layer is glass 1210 or anothersemi-transparent material, and the casing 1220 is the bottom layer. Thecomponents of the load casing 1220 are housed within the casing 1250 andaffix to the top layer 1210. The feet 1260 extend through the casingholes 1230. There may be no external buttons or switches on the scale,but a display of numbers 1240, functioning as part of the display module1060, may be housed within the casing 1250.

FIG. 13A is an exploded view illustrating a load detecting moduleaccording to one embodiment of the disclosure. The load detecting module1020 includes load casing 1220, a load cell 1310 and foot 1260. The loadcell 1310 is embedded within the load casing 1220. The load casing 1220is affixed to the top glass layer 1210, and force is exerted through tothe foot 1260 enabling the load cell 1310 to deform and detect loadchange, in accordance with one embodiment of the present invention.

FIG. 13B is a side perspective view illustrating a load detecting moduleaccording to one embodiment of the disclosure. FIG. 13B illustrates howthe components of the load detecting module 1020: the foot 1260, loadcell casing 1220, and load cell 1310, fit together.

FIG. 14A is a side perspective view illustrating a scale balance deviceaccording to one embodiment of the disclosure. FIG. 14B shows a rearperspective view of one version of the balance device. In thisembodiment, the casing 1250 is not completely matching the area of thetop layer 1210 but, instead, is a shaped casing 1250 with partialcoverage.

FIG. 15 is a plan view illustrating a scale balance device and displayaccording to one embodiment of the disclosure. The display module 1060may include four 7-66segment LEDs 1240 at least 2″ long, and a pluralityof LED lights 1510 throughout the casing to provide a glowingillumination effect through the semi-transparent top surface 1210 of thebalance device 1010. The glowing illumination provides an indication offall risk determined at block 340 of FIG. 3: red is high risk 710,yellow is moderate risk 720, and green is low risk 730 of falling, inaccordance with one embodiment of the present invention. The size of thenumbers 1240 and illuminating the risk factors may be sized to providethe user their result without requiring the user to bend down to see thedisplay 1240.

Standard materials, well known in scale construction can be used to makethe scale. This may include plastic injection molding for the casing1250, load casing 1220, and feet 1260, tempered glass for the top layer1210 that is made semi-transparent by film, etching, paint or anycombination of those techniques.

In one embodiment, the balance measuring scale may be absent of anyexternal buttons and switches so as to not require user inputs. Thescale 1010 also includes illuminating numbers 1240, preferably at leastabout two inches long, that illuminate a visual display 1060 on abalance device 1010 that is low profile and more narrow than the widthof standard walker axles. Utilizing an array of metrics from two modelsof postural control creates a robust measurement system for balance andfall risk detection. The outcome of which is the capability to detectbalance and fall risk during a safe testing procedure, standing witheyes open, with no disruptors or sensory manipulations. Furthermore, thecomposite balance score 430 may simplify highly complex analyticsnecessary to depict postural stability to a single balance score from 1to 10 that is easily comprehended by a user. Altogether, this systemprovides seniors or any users the ability to test themselvesunsupervised, without either a clinician or an assistant.

In use, a user would mount the scale 1010 and adopt a comfortablestanding position, keeping as still as possible. There may he anotification on the scale 1010 and/or communication module 1040 toindicate the test has commenced. In one embodiment, the test duration is60 seconds. At the end of the test, there may be a notification soundand/or light to signify the test completion. The weight may be displayedon the scale 1010 and/or a linked mobile device. Then, the balance scoremay be displayed 1060 on the scale 1010 and/or the linked mobile device.The fall risk may also be displayed 1060 on the scale 1010 and/or alinked mobile device, such as via an illuminated display 1060 wherecolor represents the risk classification.

Embodiments of the invention above describe the use of a machinelearning algorithm and various metrics, such as basic PEM metrics andadvanced PEM metrics, to estimate an individual's fall risk. Eachindividual metric, whether PEM or basic, has limited discriminatorypower for detecting instability when viewed in isolation. For example,FIGS. 16A-C show marginal or little difference in results between eyesopen and eyes closed conditions for normal subjects for PEM metrics,such as the number of equilibrium shown in FIG. 16A, equilibrium dwelltime shown in FIG. 16B, and the basic metric of 95% confidence swayellipse shown in FIG. 16C. Consequently, it was unexpected that the samemetrics when combined with advanced PEM metrics (such as metrics thattake into account the relationship in time and space between posturalstates generated by a HMM), correctly identified individuals who are atrisk of falling in a study of 78 older adults that includedself-testing. The advantage of the PEM analysis is that greater dynamismis detected so a safe, eyes open standing protocol can be used andself-testing is possible without placing the individual at risk. This isin contrast to most balance tests that challenge the balance of thesubject to expose weaknesses, often requiring a clinician/operator to beready to catch to treat an individual that falls.

The schematic flow chart diagrams of FIG. 2, FIG. 3, and FIG. 4 aregenerally set forth as a logical flow chart diagram. As such, thedepicted order and labeled steps are indicative of aspects of thedisclosed method. Other steps and methods may be conceived that areequivalent in function, logic, or effect to one or more steps, orportions thereof, of the illustrated method. Additionally, the formatand symbols employed are provided to explain the logical steps of themethod and are understood not to limit the scope of the method. Althoughvarious arrow types and line types may be employed in the flow chartdiagram, they are understood not to limit the scope of the correspondingmethod. Indeed, some arrows or other connectors may be used to indicateonly the logical flow of the method. For instance, an arrow may indicatea waiting or monitoring period of unspecified duration betweenenumerated steps of the depicted method. Additionally, the order inwhich a particular method occurs may or may not strictly adhere to theorder of the corresponding steps shown.

If implemented in firmware and/or software, functions described abovemay be stored as one or more instructions or code on a computer-readablemedium. Examples include non-transitory computer-readable media encodedwith a data structure and computer-readable media encoded with acomputer program. Computer-readable media includes physical computerstorage media. A storage medium may be any available medium that can beaccessed by a computer. By way of example, and not limitation, suchcomputer-readable media can comprise random access memory (RAM),read-only memory (ROM), electrically-erasable programmable read-onlymemory (EEPROM), compact disc read-only memory (CD-ROM) or other opticaldisk storage, magnetic disk storage or other magnetic storage devices,or any other medium that can be used to store desired program code inthe form of instructions or data structures and that can be accessed bya computer. Disk and disc includes compact discs (CD), laser discs,optical discs, digital versatile discs (DVD), floppy disks and Blu-raydiscs. Generally, disks reproduce data magnetically, and discs reproducedata optically. Combinations of the above should also be included withinthe scope of computer-readable media.

In addition to storage on computer readable medium, instructions and/ordata may be provided as signals on transmission media included in acommunication apparatus. For example, a communication apparatus mayinclude a transceiver having signals indicative of instructions anddata. The instructions and data are configured to cause one or moreprocessors to implement the functions outlined in the claims.

Although the present disclosure and certain representative advantageshave been described in detail, it should be understood that variouschanges, substitutions and alterations can be made herein withoutdeparting from the spirit and scope of the disclosure as defined by theappended claims. Moreover, the scope of the present application is notintended to be limited to the particular embodiments of the process,machine, manufacture, composition of matter, means, methods and stepsdescribed in the specification. For example, although processors aredescribed throughout the detailed description, aspects of the inventionmay be executed by any type of processor, including graphics processingunits (GPUs), central processing units (CPUs), digital signal processors(DSPs), application-specific integrated circuits (ASICs), and/or othercircuitry configured to execute firmware or software that executes theinstructions and methods described above. As one of ordinary skill inthe art will readily appreciate from the present disclosure, processes,machines, manufacture, compositions of matter, means, methods, or steps,presently existing or later to be developed that perform substantiallythe same function or achieve substantially the same result as thecorresponding embodiments described herein may he utilized. Accordingly,the appended claims are intended to include within their scope suchprocesses, machines, manufacture, compositions of matter, means,methods, or steps.

What is claimed is:
 1. A method, comprising: receiving, by a processor,a plurality of load data points over a period of time from at least twoload detecting modules; and estimating, by the processor, a fall risk byapplying a machine learning algorithm to the plurality of load datapoints, wherein the step of estimating the fall risk comprises:calculating center of pressure (COP) data based, at least in part, onthe plurality of load data points; determining a plurality of posturestates identified with Hidden Markov Model techniques based, at least inpart, on the center of pressure (COP) data; calculating one or more basepunctuated equilibrium model (PEM) stability metrics based, at least inpart, on the plurality of posture states; calculating one or moreadvanced punctuated equilibrium model (PEM) stability metrics based, atleast in part, on the plurality of posture states; and determining thefall risk based, at least in part, on the one or more base punctuatedequilibrium model (PEM) stability metrics and on the one or moreadvanced punctuated equilibrium model (PEM) stability metrics.
 2. Themethod of claim 2, wherein the step of estimating the fall risk furthercomprises calculating at least one basic non-PEM metric from COP.
 3. Themethod of claim 2, wherein the at least one basic non-PEM metriccomprises at least one of COP speed, peak mediolateral sway, peakanterior-posterior sway, standard deviation of mediolateral sway,standard deviation of anterior-posterior sway, mean speed, fraction oftrial above a predetermined speed, radius of a 95% sway ellipse, radiusof a 95% sway circle, and root mean square (RMS) speed.
 4. The method ofclaim 2, further comprising calculating a balance score by linearlyintegrating weighted metrics of the one or more base PEM stabilitymetrics, the one or more advanced PEM stability metrics, and the atleast one basic non-PEM metric.
 5. The method of claim 1, wherein theone or more base PEM stability metrics comprise at least one of a numberof equilibria, a dwell time in an equilibrium, and a size of eachequilibrium.
 6. The method of claim 1, wherein the advanced PEMstability metrics comprise at least one of a time to equilibrium, anequilibrium distance, an equilibrium overlap, a percent equilibrium, amean equilibria duration, and directional equilibria.
 7. The method ofclaim 1, further comprising the further step of classifying the fallrisk, wherein the fall risk classification is based on classificationthresholds comprising at least high risk, moderate risk, and low risk.8. The method of claim 1, where in the step of estimating the fall riskcomprises applying the machine learning algorithm with at least one ofclinical records, exercise, lifestyle inputs, weight, body fatcomposition, body mass index, level of hydration, medicationconsumption, alcohol consumption, sleep, steps per day, exercise, timespent sitting, and strength.
 9. The method of claim 1, wherein the stepof acquiring comprises acquiring the plurality of load data points fromat a load sensor on at least one of a scale, floor panel, mat, shoe,insole, sock, walker, walking aid, ladder, cane, prosthetic, and roboticleg.
 10. The method of claim 1, wherein the step of estimating the fallrisk further comprises determining a postural at a point in time basedon at least the plurality of postural states and a probability oftransitioning between at least one of the plurality of postural statesand another postural state, wherein the postural state is at least oneof a static postural state or a dynamic postural state
 11. A system fordetermining postural stability and fall risk of a person, comprising:two or more load detecting modules configured to acquire a plurality ofload data points; a signal preparation module coupled to the loaddetecting modules and configured to convert the plurality of load datapoints to a transmittable form; a communication module coupled to thesignal preparation module, the communication module configured to:receive the plurality of load data points from the signal preparationmodule; transmit the plurality of load data points; and a data analysismodule configured to analyze the plurality of load data points receivedfrom the signal preparation module, wherein the data analysis module isconfigured to perform steps comprising: calculating center of pressure(COP) data based, at least in part, on the plurality of load datapoints; determining a plurality of posture states identified with HiddenMarkov Model techniques based, at least in part, on the center ofpressure (COP) data; calculating one or more base punctuated equilibriummodel (PEM) stability metrics based, at least in part, on the pluralityof posture states; calculating one or more advanced punctuatedequilibrium model (PEM) stability metrics based, at least in part, onthe plurality of posture states; and determining the fall risk based, atleast in part, on the one or more base punctuated equilibrium model(PEM) stability metrics and on the one or more advanced punctuatedequilibrium model (PEM) stability metrics; and a display module coupledto the data analysis module and configured to display results from thedata analysis module comprising at least an indication of the fall risk.12. The system of claim 11, wherein the two or more load detectingmodules comprise four load detecting modules, wherein the four loaddetecting modules are housed within a casing with a transparent orsemi-transparent top layer.
 13. The system of claim 12, wherein thedisplay module comprises an illumination of the results, visible throughpart or all of the top layer.
 14. The system of claim 11, wherein thedisplay module comprises a plurality of LED light rows that produce aglow effect in at least one of red, yellow, green, blue, and white. 15.The system of claim 11, wherein the communication module is part of atleast one of a mobile device, smartwatch, smartphone, tablet, computer,and wearable.
 16. An apparatus, comprising: two or more load detectingmodules configured to acquire a plurality of load data points; a signalpreparation module coupled to the load detecting modules and configuredto convert the plurality of load data points to a transmittable form; acommunications module coupled to the signal preparation module andconfigured to: transmit the plurality of load data points to a dataanalysis module; and receive, from the data analysis module, a fall riskcalculated by a machine learning algorithm based, at least in part, onone or more base punctuated equilibrium model (PEM) stability metricsand on one or more advanced punctuated equilibrium model (PEM) stabilitymetrics; and a display module configured to display an indication of thereceived fall risk.
 17. The apparatus of claim 16, wherein the two ormore load detecting modules are housed within a casing with atransparent or semi-transparent top layer, and wherein the displaymodule comprises an illumination of the fall risk, visible through partor all of the top layer.
 18. The apparatus of claim 16, wherein thedisplay module comprises a plurality of LED lights that produce a gloweffect corresponding to a classification of the fall risk.
 19. Theapparatus of claim 16, wherein the communications module is configuredto communicate with the data analysis module through a mobile device.20. The apparatus of claim 16, wherein the communications module isconfigured to communicate with the data analysis module through theInternet.